Clinical perspectives to improve pregnancy outcome in women undergoing chronic hemodialysis

Severe Chronic Kidney Disease is considered a powerful method of contraception per se, and pregnancy among women undergoing chronic hemodialysis is a rare event. Women on dialysis usually have amenorrhea or irregular menstrual cycles and sexual dysfunction. They are often unaware of their pregnancy, which delays the diagnosis and the beginning of adequate obstetric-nephrological care, increasing the risk of maternal and fetal complications including pre-eclampsia, fetal growth restriction, preterm delivery, and perinatal death. However, pregnancy among women on dialysis is increasing exponentially around the world. The authors present the two last pregnancies of patients on dialysis followed in their hospital, review clinical procedures, and the improvements of medical care during gestation used to contribute to a successful gestation outcome. Pregnancy is possible in women on chronic hemodialysis.

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Pregnancy Outcomes in French Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000488286 ◽

2018 ◽

Vol 47 (4) ◽

pp. 219-227 ◽

Cited By ~ 5

Author(s):

Gabrielle Normand ◽

Xiaoli Xu ◽

Marine Panaye ◽

Anne Jolivot ◽

Sandrine Lemoine ◽

...

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Primary Outcome ◽

Rare Event ◽

Third Trimester ◽

The Third ◽

Daily Dialysis ◽

Fetal Complications ◽

Medical Counseling ◽

Residual Diuresis

Background: Pregnancy in hemodialysis (HD) women is a rare event and often associated with maternal and fetal complications. Scarcity of available data from large cohorts impedes fair medical counseling. Methods: This is a descriptive, retrospective, multi-centric study. Pregnant women on HD during the period from 1985 to 2015 in France were included. The primary outcome was a living infant discharged from hospital, while secondary outcomes included gestational age and birth weight. Results: We identified 100 pregnancies in 84 women on HD, from 41 centers. Chronic HD was initiated during pregnancy for 17.7% (14/79) of patients explaining a 19.8% prevalence of catheter (19/96) and a preserved residual diuresis for 50% of pregnancy (43/86). Seventy-six (89.4%) women performed daily dialysis during the third trimester (6 times per week). Our primary outcome was met for 78% of newborns with a mean gestational age of 33.2 ± 3.9 weeks and a mean birth weight of 1,719 ± 730 g. Conclusions: Our study is one of the largest series of pregnancies in HD patients. Despite recent progresses, these pregnancies remain at high risk, reinforcing the need for an early nephrologist-obstetrician skilled team co-management.

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Hyperthyroidism in Pregnancy: the Delicate Balance between too Much or too Little Antithyroid Drug

10.20944/preprints202106.0717.v1 ◽

2021 ◽

Author(s):

Monica Livia Gheorghiu ◽

Roxana Georgiana Bors ◽

Ancuta Augustina Gheorghisan-Galateanu ◽

Anca Lucia Pop ◽

Dragos Cretoiu ◽

...

Keyword(s):

Thyroid Function ◽

Perinatal Death ◽

Antithyroid Drug ◽

Antithyroid Drugs ◽

Premature Delivery ◽

Control Group ◽

Preg Nancy ◽

Fetal Complications ◽

Neonatal Hyperthyroidism

Overt hyperthyroidism during pregnancy is associated with risk of maternal-fetal complications. The antithyroid drugs (ATD) have a potential risk for teratogenic effects and fetal–neonatal hy-pothyroidism. This study evaluated ATD treatment and thyroid function control during preg-nancy, and pregnancy outcome in women with hyperthyroidism. Patients and methods: retro-spective analysis of 36 single fetus pregnancies in 29 consecutive women (median age 30.3 ± 4.7 years) with hyperthyroidism diagnosed before or during pregnancy; a control group of 39 healthy euthyroid pregnant women was used. Results: 26 women had Graves’ disease (GD, 33 pregnan-cies), 1 had a hyperfunctioning autonomous nodule, 2 had gestational transient thyrotoxicosis (GTT). Methimazole (MMI) was administered in 22 pregnancies (78.5%), Propylthiouracil (PTU) in 2 (7.1%), switch from MMI to PTU in 4 (14.2%), no treatment in 8 pregnancies (3 with subclinical hyperthyroidism, 5 euthyroid with previous GD remission before conception). One spontaneous abortion at 5 weeks (3.4% of pregnancies) and 1 premature delivery at 32 weeks with perinatal death in 24h (3.4%) were recorded in 2 of the 8 pregnancies of GD patients diagnosed shortly before (< 6 weeks) or during gestation. In women treated more than 6 months until conception (20 pregnancies): a) median ATD doses were lower than those in women diagnosed shortly before or during pregnancy; b) ATD was withdrawn in 40% of pregnancies in trimester (T) I, all on MMI < 10 mg/day (relapse in 14.2%), and in up to 55% in TIII; c) TSH level was below normal in 37%, 35% and 22% of pregnancies in T I, II and III respectively; FT4 was increased in 5.8% (T I) and sub-normal in 11.75% in TII and III; d) one fetal death due to a true umbilical cord knot was recorded. Hyperthyroidism relapsed postpartum in 83% of GD patients (at median 3 ± 2.6 months). One child had neonatal hyperthyroidism (3.3% of live children in GD women) and a small atrial sept defect (4% of live children in ATD treated women). Mean birth weight did not differ from that of the control group. Conclusion. In hyperthyroid women with long-term ATD control before con-ception, drugs could be withdrawn in TI in a third of them, and fetal complications were rare. Frequent serum TSH and FT4 monitoring is needed in order to maintain optimal thyroid function during pregnancy.

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Management of pre-eclampsia and its complications in the department of gynecology and obstetrics at Donka national hospital Conakry, Guinea

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201770 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1858

Author(s):

Diallo Alpha Boubacar ◽

Omou Hawa Bah ◽

Ibrahima Conté ◽

Ibrahima Sory Sow ◽

Ibrahima Koussi Bah ◽

...

Keyword(s):

Pregnant Women ◽

Fetal Death ◽

Perinatal Death ◽

Multidisciplinary Care ◽

Fetal Distress ◽

National Hospital ◽

Cross Sectional ◽

Gynecology And Obstetrics ◽

Fetal Complications ◽

Visual Disturbances

Background: Vascular-renal syndrome, also known as pre-eclampsia, is a condition specific to pregnancy, usually occurring in the last trimester of pregnancy. Pregnant women are sometimes at risk of unpredictable obstetrical complications such as: hemorrhage, kidney failure, HELLP syndrome, sometimes even brain damage requiring prompt care and multidisciplinary collaboration. Vascular-renal syndromes are the third leading cause of maternal death and also the world's leading cause of perinatal death. Objectives of this study were to analyse the management of vascular-renal syndromes. Calculate their frequency, describe the sociodemographic characteristics of patients, describe the clinical and biological signs of patients, evaluate the maternal-fetal prognosis.Methods: The study was conducted in the department of obstetrics and gynecology of Donka National Hospital. It was a prospective, descriptive, cross-sectional, 6-month study from March 1st to August 31st, 2015, of pregnant women with pre-eclampsia.Results: The study included 217 cases of pre-eclampsia out of a total of 3054 patients, i.e. a proportion of 7.10%. The proportion of pre-eclampsia was high in patients aged between 15 and 19 years, housewife, married, primary. The predisposing factors were primigestitis, obesity and twinkling. The clinic was dominated by headaches and visual disturbances. Severe preeclampsia in 78.49%, eclampsia in 21.65% or simple hypertension in 1.75%. Maternal and fetal complications were dominated by eclampsia 26.26%, PPH (2.63%), eclamptic coma (0.46%), acute fetal distress 27.19%, and fetal death in utero (11.40%). In order to improve maternal and fetal prognosis it is necessary to provide multidisciplinary care, which unfortunately is not always available in our context.Conclusions: Obstetric emergency is a frequent situation for which a better management would improve the maternal-fetal prognosis.

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Acute splenic sequestration in a pregnant woman with homozygous sickle-cell anemia

Sao Paulo Medical Journal ◽

10.1590/s1516-31802013000100023 ◽

2013 ◽

Vol 131 (2) ◽

pp. 123-126 ◽

Cited By ~ 2

Author(s):

Carolina Bastos Maia ◽

Roseli Mieko Yamamoto Nomura ◽

Ana Maria Kondo Igai ◽

Guilherme Hencklain Fonseca ◽

Sandra Menosi Gualandro ◽

...

Keyword(s):

Case Report ◽

Sickle Cell ◽

Sickle Cell Anemia ◽

Fetal Heart ◽

Rare Event ◽

Fetal Distress ◽

Cell Disease ◽

Splenic Sequestration ◽

Good General Condition ◽

Fetal Complications

CONTEXT Homozygous (SS) sickle-cell anemia complicated by acute splenic sequestration in adults is a rare event, and it has never been reported during pregnancy. CASE REPORT A 25-year-old woman with homozygous (SS) sickle-cell disease was hospitalized at 32 weeks' of gestation presenting weakness, abdominal pain, fever and hemoglobin of 2.4 g/dl. Abnormal fetal heart rate was detected by means of cardiotocography, and 5 units of packed red cells were transfused. Cesarean was performed at 37 weeks. Both mother and baby were discharged in a good general condition. CONCLUSION This case report demonstrates the importance of immediate blood transfusion for treatment of fetal distress in cases of splenic sequestration during pregnancy. This treatment is essential for avoiding maternal and fetal complications.

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Perinatal Outcome of Premature Rupture Membrane in Pregnancy

Journal of Dhaka Medical College ◽

10.3329/jdmc.v26i2.38831 ◽

2018 ◽

Vol 26 (2) ◽

pp. 135-139

Author(s):

Housneara Begum ◽

Marlina Roy ◽

Nahid Reaz Shapla

Keyword(s):

Perinatal Mortality ◽

Perinatal Death ◽

Correct Diagnosis ◽

Mortality And Morbidity ◽

Medical College ◽

Intact Membrane ◽

Fetal Complications ◽

Statistical Program ◽

Antibiotic Coverage ◽

In Pregnancy

Objective: To find out the effect of PROM on neonatal outcome so that we can pay more attention for the correct diagnosis and management of PROM in pregnancy which can reduce the perinatal mortality and morbidity caused by PROM.Methods: One hundred PROM cases were selected maintaining appropriate inclusion & exclusion criteria from the department of obstetrics & Gynaecology of BSMMU & DMCH and one hundred controlled cases were taken from the same during the period of January 2010 to December 2010. Data were analyzed with SPSS statistical program to determine the effect of PROM on neonatal health.Results: In this study, 44% babies of PROM patients had various type of morbidity compare to 24% of patients with intact membrane. In PROM patients, perinatal mortality was 7% in this study compare to 5% with intact membrane. Causes of perinatal death in PROM was severe asphyxia (4%), RDS (5%) & neonatal sepsis (6%) mainly.Conclusion: All fetal complications were significantly higher in PROM patients who received treatment after prolonged rupture of membrane. Appropriate antibiotic coverage in appropriate time will reduce fetal morbidity.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 135-139

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Quantitative Assessment of HCV Load in Chronic Hemodialysis Patients

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700070004 ◽

1999 ◽

Vol 20 (02) ◽

pp. 123

Author(s):

Gina Pugliese ◽

Martin S. Favero

Keyword(s):

Quantitative Assessment ◽

Hemodialysis Patients ◽

Chronic Hemodialysis

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Multidisciplinary Evidence to Treat Bilingual Individuals with Aphasia

Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations ◽

10.1044/cds15.3.66 ◽

2008 ◽

Vol 15 (3) ◽

pp. 66-72 ◽

Cited By ~ 1

Author(s):

José G. Centeno

Keyword(s):

Stroke Rehabilitation ◽

Culturally Diverse ◽

Treatment Strategies ◽

The United States ◽

Intervention Strategies ◽

Steady Increase ◽

Clinical Procedures ◽

Bilingual Speakers ◽

Aphasic Clients

Abstract The steady increase in linguistic and cultural diversity in the country, including the number of bilingual speakers, has been predicted to continue. Minorities are expected to be the majority by 2042. Strokes, the third leading cause of death and the leading cause of long-term disability in the U.S., are quite prevalent in racial and ethnic minorities, so population estimates underscore the imperative need to develop valid clinical procedures to serve the predicted increase in linguistically and culturally diverse bilingual adults with aphasia in post-stroke rehabilitation. Bilingualism is a complex phenomenon that interconnects culture, cognition, and language; thus, as aphasia is a social phenomenon, treatment of bilingual aphasic persons would benefit from conceptual frameworks that exploit the culture-cognition-language interaction in ways that maximize both linguistic and communicative improvement leading to social re-adaptation. This paper discusses a multidisciplinary evidence-based approach to develop ecologically-valid treatment strategies for bilingual aphasic individuals. Content aims to spark practitioners' interest to explore conceptually broad intervention strategies beyond strictly linguistic domains that would facilitate linguistic gains, communicative interactions, and social functioning. This paper largely emphasizes Spanish-English individuals in the United States. Practitioners, however, are advised to adapt the proposed principles to the unique backgrounds of other bilingual aphasic clients.

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